From Bob's Cluttered Desk

Psychosocial Disability, or, There is Something Fishy About a Man Named Guppy

05/14/15

Robert Wilson

It was a bit eerie, actually. My presentation last week at the Washington Self-Insurers Association Annual Conference was followed by Vickie Kennedy and Ryan Guppy of Washington Labor & Industry. Kennedy is the Assistant Director for Insurance Services, and Guppy serves in the role of Chief of Return to Work Partnerships. In my presentation I talked about perceptions, responsibilities and the importance of communication in the handling of any workers' compensation claim. In their session they spoke about perceptions, responsibilities and the importance of communication in the handling of any workers' compensation claim.

While this sounds on the surface as though it was an unplanned redundancy, my impression of the event was that the two sessions dovetailed rather nicely into a cohesive message for the audience. To be truthful, their message is probably the one that brought the "cohesive" component. My presentations, often theoretical and more of the "pay no attention to that man behind the curtain" variety, often flap aimlessly around the room hoping to stick to anything useful. Their session was more structured, and offered definitive points and statistics for consideration.

We should take this act on the road.

Kennedy and Guppy spoke about the importance of an Early Return to Work strategy, and discussed extensively the challenges of changing the culture, as well as identifying barriers, needs, and motivational issues early in the claim process. The most compelling point from them (at least to me) was the discussion pertaining to psychosocial factors that employers and carriers should be keenly aware of in any claim, as they can have dramatic impact on outcome for all involved. Guppy really drove the point home when he spoke about "perceptions".

(This is the point where I steal all their bullet points)

Saying that addressing psychosocial issues was "not practicing or employing psychology", he emphasized to the employers in the room that should they fail to recognize the perception trends and influences of an injured worker in the system, they would ultimately pay for psych in the end. He offered these points on "Perceptions", and their impact on an injured worker:

Individuals who have high perceptions of injustice experience more pain, more emotional distress, and more disability.

They are more invested in proving their disability than in focusing on recovery goals

They are less likely to participate in rehabilitation interventions and are less likely to return to work.

One of those points hit me like a truck. "They are more invested in proving their disability than in focusing on recovery goals." I had never really thought about it, but as I reviewed the many conversations with injured people I've had over the years, I realized it made sense. People who have become impaired through workplace accidents not only are often being led to believe they are disabled; they become the chief proponent of their newly gained inability to function.

There are those out there for whom it becomes more important to be perceived as disabled than to learn to cope with impairment and move on. It is largely part of what I refer to in my own presentations when I speak of people “owning their disabilities”. I often stress that people must accept their condition and work forward from that point of impairment; they must either own their disability, or it will most assuredly own them.

They then moved into identifying common psychosocial variables connected to workplace disability. They listed:

Catastrophic thinking

Fear (and avoidance)

Perceived disability

The first point, Catastrophic thinking, is often a product of failed communication in the claims process. These people are confused, both lost in and dependent on a system they do not understand. I've said this before, in the absence of solid information, cancerous thoughts will grow. The 3 elements of catastrophic thinking, rumination (excessively focusing on symptoms), magnification (perception of the situation being much worse than reality), and helplessness (a belief that one is powerless to control their situation) all are reflected by that concept.

The second point, Fear, was largely related to pain. This fear drives avoidance of activities that may cause more pain. Guppy and Kennedy pointed out that avoidance of activity can lead to deconditioning, decreased overall health and, again, perceived disability.

This fits nicely with their third point. An individual's belief that they are disabled and unable to engage in work/life activities is the result of catastrophic thinking and fear. The pair pointed out that people who suffer from this are typically “out of touch with what would be expected given their injury”.

Finally, on another point where our presentations meshed well, they pointed out that impairment and disability are two very different things. Impairment is the physical reality, but disability is determined by how the person chooses to deal with that impairment. Psychosocial influences will often make that critical distinction.

The point here, of course, is that recognizing injured workers are lost within our system; that they are confused and afraid, is the first step in producing a better outcome for them down the road. Taking the time to communicate process and recognizing that lives and livelihood are hanging in the balance are efforts with a tremendous potential payoff. It turns out we literally can talk our way out of a bad result. As long as, that is, we start talking early on.

I've had the pleasure of working with both Vickie and Ryan on the Disability Management and Return to Work Committee at the IAIABC. They are a lot of fun, and it was a pleasure to get to see them present. They did an excellent job. I hope everyone will benefit from the information they shared.

Even if there is something fishy about a man named Guppy…..

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Robert Wilson is President & CEO of WorkersCompensation.com, and "From Bob's Cluttered Desk" comes his (often incoherent) thoughts, ramblings, observations and rants - often on workers' comp or employment issues, but occasionally not.

Bob has a couple unique personality characteristics. He firmly believes that everyone has the right to his (Bob's) opinion, and while he may not always be right, he is never in doubt. Enter at your own risk, and like all of our blog areas, we encourage you to read the disclaimer at the bottom of the page.

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Bob is an accomplished speaker for the workers' compensation industry. He is available for conferences, corporate events, children's birthday parties and Bar Mitzvahs. You may access his Speakers Brief here.